Healthcare Provider Details

I. General information

NPI: 1558941328
Provider Name (Legal Business Name): BODY HACK HIGH PERFORMANCE PT PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1042 JACKSON AVE
LONG ISLAND CITY NY
11101-5819
US

IV. Provider business mailing address

9972 66TH RD APT 1T
REGO PARK NY
11374-4440
US

V. Phone/Fax

Practice location:
  • Phone: 718-433-9909
  • Fax: 718-433-9676
Mailing address:
  • Phone: 917-733-3795
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. CARLOS HUMBERTO ZORRILLA
Title or Position: PHYSICAL THERAPIST
Credential: PT
Phone: 646-238-3090